The annual meeting of the American Society of Clinical Oncology (ASCO) says goodbye this Tuesday after having presented for five days more than 2,900 works that provide new knowledge against cancer. Some research is underway and it is possible that next year will show definitive conclusions.
Covering this wealth of information generated at the congress, in which 43,<> doctors from all over the world participate, is impossible. But some research in particular deserves greater dissemination than others, both because of the incidence of the type of cancer on which they work and because of the potential benefits they can bring.
From this endless accumulation of material, during the last days three important works on breast cancer, lung cancer and melanoma were presented. In each case, there is a new contribution to the treatment of the disease, either through a possible modification in the way of approaching it or the confirmation that the chosen path is the correct one.
In this research it is evident how the cure of cancer or survival depends not only on the emergence of innovative drugs (something that is always decisive), but also on finding new combinations of administration of existing ones.
Less chemotherapy
A clear example of the latter hypothesis was reflected in a phase II study by Spanish researchers. He concluded, for the first time, that monoclonal antibodies against certain very aggressive breast cancers may be more effective alone than accompanied by chemotherapy. The work was conducted by the International Breast Cancer Center and the oncology clinical research company MEDSIR.
One of ASCO's busy halls in Chicago, which comes to an end on Tuesday. Photo: EFE
The study, called PHERGain, included 356 people with early-stage localized HER2+ breast cancer. The researchers' idea was to promote that chemotherapy is an option and not administered by default. That is, the decision depends on how the patient responds, with the aim of reducing the level of toxicity and achieving fewer side effects. Thus, they managed to reduce the number of patients receiving chemo by 30 percent.
"The 3-year invasive disease-free survival in the group of patients treated with this adapted design was 95.4 percent. Unfortunately, we had 9 metastatic events, but this compares strikingly with what we might expect with the standard chemotherapy treatment, trastuzumab and pertuzumab," said the study's lead author, Javier Cortés, of the Ramón y Cajal University Hospital in Madrid.
Patients were considered to respond to antibodies if the scan showed a reduction in breast lesions of at least 40 percent from baseline. The possibility of a chemotherapy-free regimen for patients with HER2-positive disease, the doctors said, offers a potential alternative for people who don't need or can't tolerate chemotherapy.
Targeted therapies
Another of the advances presented was the discovery that a drug that was already used provides greater benefits than previously believed. In this case it is a treatment against lung cancer after surgery discovered a new way that increases survival in patients in whom a mutation of the EGFR gene has been detected. It was with the use of the drug osimertinib, according to the conclusions of the trial named ADAURA.
Lung cancer has the highest incidence overall. Photo: Shutterstock.
A total of 682 patients between the ages of 30 and 86 participated in the study. Five years after the operation, the risk of death in patients treated with osimertinib was 51 percent lower than in those who received placebo. The survival rate was also 88 percent for the first group and 78 percent among those who stayed on the placebo.
"The EGFR mutation occurs in 12 to 15 percent of patients. This medication had already shown that patients who took it reduced the possibility of the tumor returning, compared to not taking it," Claurio Martín, secretary of the Argentine Society of Clinical Oncology, present at ASCO, told Clarín.
Martin added: "It has now been shown that patients who take this pill, which is administered orally for three years, a percentage of them are cured. The medication is already approved in Argentina and is being used. But the question was whether it only delayed the possibility of the tumor coming back or also had this other virtue."
Road to the vaccine
A third work featured at ASCO is on melanoma. In this case it has to do with a treatment that does not yet exist, but that has shown promising results in the research instance.
It focuses on a vaccine tested in phase 2 that managed to reduce the risk of relapse or death. Their treatment uses messenger RNA technology, the same one used for the Covid vaccine. It allows the body to inject into the body the instructions or molecules that teach cells to produce proteins that stimulate an immune response.
Permanent exchanges between doctors participating in the world's largest cancer event Photo: EFE
This therapy is able to train and activate a patient's immune system to attack so-called neoantigens (abnormal proteins that cancer cells produce) on the surface of the tumor. As they explained, the mechanism of immune stimulation and training is very similar to what vaccines do.
The trial was in the United States and Australia before the Covid pandemic and was conducted on 157 people with high-risk melanoma, who had already had surgery to remove it. Of the total, 107 received the vaccine in combination with pembrolizumab and 50, pembrolizumab alone.
The study demonstrated a statistically and clinically meaningful improvement in combination therapy compared to treatment with pembrolizumab alone, with a reduced risk of recurrence or death by 44 percent. After 18 months, the group that received the combination had a 78.6 percent cancer-free survival and 62.2 percent in the second.
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